Pinnacle Workshop | Performex- Consultants In Performance Excellence and Management Leadership

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Pinnacle Workshop Registration

To register for our Pinnacle Workshop Program, please fill out the following multi-page form in its entirety. If you wish to register by phone, call (949) 759-1928. To find out more about the Pinnacle Workshop Program and how it can help you and your company excel in the areas of management and leadership please click HERE!

NOTE: A (*) shown after a question or field indicates that question or field is required to be filled with the corresponding information.

RELATIONSHIP	EXAMPLE
Administrative Point of Contact =	This is the primary person responsible for entering the data into this form. This can be an office administrator, secretary or the actual Participant or Supervising Manager
Participant =	Individual for which the Survey is about
Supervising Manager =	The Individual for whom the Participant report to

Workshop Dates & Places:
Choose A Pinnacle Workshop Date and Location:(*)

Invalid Input

Workshop Participant Information:

HINT: Participant =Individual for which the Survey is about
Full Name(*)

Please Type The Participants Full Name
Title

Please Type The Participants Title
Company(*)

Please Type The Participants Company Name
Address 1(*)

Please Type The Participants Address
Address 2

Invalid Input
City(*)

Please Type The Participants City
State(*)

Please Type The Participants State
Zip Code(*)

Please Type Your Zip Code
Email Address(*)

Please Type The Participants Email Address
Phone(*)

Please Type The Participants Phone Number
Ext.

Please Type Participants Extension
Fax

Please Type Participants Fax Number

Supervisor Information:

HINT: Supervising Manager - The individual for whom the Paticipant reports to
Full Name(*)

Please Type The Participants Full Name
Title

Please Type The Participants Title
Company(*)

Please Type The Participants Company Name
Address 1(*)

Please Type The Participants Address
Address 2

Invalid Input
City(*)

Please Type The Participants City
State(*)

Please Type The Participants State
Zip Code(*)

Please Type Your Zip Code
Email Address(*)

Please Type The Participants Email Address
Phone(*)

Please Type The Participants Phone Number
Ext.

Please Type Participants Extension
Fax

Please Type Participants Fax Number

Administrative Point of Contact Information: (if you are not the workshop participant)

HINT: Administrative Point of Contact = This is the primary person responsible for entering the data into this form. This can be an office administrator, secretary or the actual Participant or Supervising Manager
Full Name(*)

Please Type The Participants Full Name
Title

Please Type The Participants Title
Company(*)

Please Type The Participants Company Name
Address 1(*)

Please Type The Participants Address
Address 2

Invalid Input
City(*)

Please Type The Participants City
State(*)

Please Type The Participants State
Zip Code(*)

Please Type Your Zip Code
Email Address(*)

Please Type The Participants Email Address
Phone(*)

Please Type The Participants Phone Number
Ext.

Please Type Participants Extension
Fax

Please Type Participants Fax Number

Billing Information:

HINT: Billing Contact = The individual responsible for approving and processing the bills for payment
Full Name(*)

Please Type The Participants Full Name
Title

Please Type The Participants Title
Company(*)

Please Type The Participants Company Name
Address 1(*)

Please Type The Participants Address
Address 2

Invalid Input
City(*)

Please Type The Participants City
State(*)

Please Type The Participants State
Zip Code(*)

Please Type Your Zip Code
Email Address(*)

Please Type The Participants Email Address
Phone(*)

Please Type The Participants Phone Number
Ext.

Please Type Participants Extension
Fax

Please Type Participants Fax Number
Click to Submit Your Request

Specialist in Management and Leadership Excellence